Abstract
PURPOSE: This study was designed to determine the anastomotic leak rate, local recurrence rate, and survival of patients undergoing anterior resection with the double-stapling technique for rectal cancer. METHODS: Between 1981 and 1992, 189 patients underwent a curative (166) or palliative (23) anterior resection using the double-stapling technique. A chart review was performed, and follow-up information was obtained from the patient or family physician. Follow-up was complete in 186 patients (98 percent). RESULTS: There were five (2.6 percent) stapler-related complications, of which two patients required a defunctioning colostomy. Postoperative mortality was 1.6 percent, and clinical leak rate was 7.3 percent. Clinical leak rate was significantly higher in patients with lesions in the lower third (20 percent) compared with those in the middle and upper thirds (9 and 1 percent, respectively;P <0.05). After a mean follow-up of 32±29 months, local recurrence rate was 9.1 percent but was significantly higher in patients more than 65 years old (14 vs.1 percent;P <0.005) and in patients with resection margins less than 2.0 cm (17 vs.5.5 percent;P <0.05). Five-year survival was 78 percent. CONCLUSIONS: Anterior resection performed with the double-stapling technique has an acceptable clinical leak rate, local recurrence rate, and survival rate. However, the clinical leak rate appears to be increased in patients with low tumors and, therefore, a defunctioning colostomy should be considered. Resection margins of more than 2 cm are necessary.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Knight CD, Griffen FD. An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 1980;88:710–4.
Cohen Z, Myers E, Langer B, Taylor B, Railton RH, Jaimeson C. Double stapling technique for low anterior resection. Dis Colon Rectum 1983;26:231–5.
Feinberg SM, Parker F, Cohen Z,et al. The double stapling technique for low anterior resection of rectal carcinoma. Dis Colon Rectum 1986;29:885–90.
Heald R, Leicester R. The low stapled anastomosis. Br J Surg 1981;68:333–7.
Everett WG, Friend PJ, Forty J. Comparison of stapling and hand-suture for left-sided large bowel anastomosis. Br J Surg 1986;73:345–8.
McGinn FP, Gartell PC, Clifford PC, Brunton FJ. Staples or sutures for low colorectal anastomoses: a prospective randomized trial. Br J Surg 1985;72:603–5.
Brennan SS, Pickford IR, Evans M, Pollock AV. Staples or sutures for colonic anastomoses—a controlled clinical trial. Br J Surg 1982;69:772–4.
Beart RW, Kelly KA. Randomized prospective evaluation of the EEA stapler for colorectal anastomoses. Am J Surg 1981;141:143–7.
West of Scotland and Highland Anastomosis Study Group. Suturing or stapling in gastrointestinal surgery: a prospective randomized study. Br J Surg 1991;78:337–41.
Picciocchi A, D'Ugo DM, Durastante V, Cardillo G. Double stapling technique for low colorectal anastomoses after anterior resection for rectal cancer. Int Surg 1988;73:19–22.
Griffin FD, Knight CD, Whitaker JM. The double staple technique for low anterior resection. Ann Surg 1990;211:745–52.
Varma JS, Chan AC, Li MK, Li AK. Low anterior resection of the rectum using a double stapling technique. Br J Surg 1990;77:888–90.
Graf W, Glimelius B, Bergstrom R, Pahlman L. Complications after double and single stapling in rectal surgery. Eur J Surg 1991;157:542–7.
Moritz E, Achleitner D, Holbling N, Miller K, Speil T, Weber F. Single vs double stapling technique in colorectal surgery: a prospective randomized trial. Dis Colon Rectum 1991;34:495–7.
Bozzetti F, Bertario L, Bombelli L,et al. Doubleversus single stapling technique in rectal anastomosis. Int J Colorectal Dis 1992;7:31–4.
Moran BJ, Blenkinsop J, Finnis D. Local recurrence after anterior resection for rectal cancer using a double stapling technique. Br J Surg 1992;79:836–8.
Baran JJ, Goldstein SD, Resnik AM. The double-staple technique in colorectal anastomoses: a critical review. Am Surg 1992;58:270–2.
Redmond HP, Austin OM, Clery AP, Deasy JM. Safety of double-stapled anastomosis in low anterior resection. Br J Surg 1993;80:924–7.
Mealy K, Burke P, Hyland J. Anterior resection without a defunctioning colostomy: questions of safety. Br J Surg 1992;79:305–7.
Antonsen HK, Kronborg O. Early complications after low anterior resection for rectal cancer using the EEA™ stapling device: a prospective trial. Dis Colon Rectum 1987;30:579–83.
Bisgaard C, Svanholm H, Jensen AS. Recurrent carcinoma after low anterior resection of the rectum using the EEA staple gun. Acta Chir Scand 1986;152:157–60.
Rosen CB, Beart RW Jr, Ilstrup DM. Local recurrence of rectal carcinoma after hand-sewn and stapled anastomoses. Dis Colon Rectum. 1985;28:305–9.
Akyol AM, McGregor JR, Galloway DJ, Murry G, George WD. Recurrence of colorectal cancer after sutured and stapled large bowel anastomoses. Br J Surg 1991;78:1297–1300.
Rubbini M, Vettorello GF, Guerrera C,et al. A prospective study of local recurrence after resection and low stapled anastomosis in 183 patients with rectal cancer. Dis Colon Rectum 1990;33:117–21.
Karanjia ND, Schache DJ, North WR, Heald RJ. “Close shave” in anterior resection. Br J Surg 1990;77:510–2.
Author information
Authors and Affiliations
Additional information
Read at the meeting of the Royal College of Physicians and Surgeons of Canada, Vancouver, British Columbia, Canada, September 10 to 13, 1993, and the Tripartite Colorectal Meeting, Sydney, Australia, October 17 to 20, 1993.
About this article
Cite this article
Laxamana, A., Solomon, M.J., Cohen, Z. et al. Long-term results of anterior resection using the double-stapling technique. Dis Colon Rectum 38, 1246–1250 (1995). https://doi.org/10.1007/BF02049147
Issue Date:
DOI: https://doi.org/10.1007/BF02049147